MEMORANDUM - Florida Health Care Plans

MEMORANDUM
TO:
Primary Care Physicians
FROM:
Tyler Staley, MD
RE:
Concussion Information
DATE: October 31, 2012
Dear Colleagues,
The management of patients with concussions, especially athletes, is constantly evolving.
Information to assist you in managing such cases is available; please see the attached Concussion
Information Sheet created by the Volusia/Flagler County Concussion Task Force. If you feel
comfortable managing these patients yourself, please follow the instructions listed in the handout,
including Form AT-18 which must be signed by the physician and the athletic trainer performing
the return to play protocol.
However, if you would prefer to refer such cases, I am happy to accept them for further evaluation
and treatment. If I cannot be reached or I am unable to see the patient at the desired date and
time, Dr. Wes Driggers is also available to see patients with a concussion. Please try to provide
the patient with the Concussion Information Sheet, which provides additional information and
instructions for patients until they can be seen. If you have questions about a patient you are
seeing in this regard, please do not hesitate to contact me.
Sincerely,
Tyler Staley, MD
Sports Medicine
Florida Health Care Plans
330 N Clyde Morris Blvd
Daytona Beach, FL 32114
386-238-3290
Attachment: Concussion

VOLUSIA FLAGLER
Concussion
TASK FORCE
Dear Provider:
John Shelton, MD
Center for Family and Sports Medicine
386.254.4165
Trish Ramsay
Center for Family and Sports Medicine
386.254.4165
Miguel Concepcion, MD
Center for Family and Sports Medicine
386.254.4165
Brent Fulton, MD
Medical Exercise Associates
386.258.9502
Katarzyna Madejczyk, MD
Halifax Health Emergency Department
Michael Fabian, MD
Halifax Health
John Hill, MD
West Volusia Family and Sports Medicine
386.774.0016
John McFarland, MS, ATC, LAT
CORA Health
386.871.7818
James Piotrowski, PA-C, MS
Neurology & Spine, LLC
386.763.4484
Jeremy Grimes, MD
Neurology & Spine, LLC
386.763.4484
Robert Sefcik, ATC, LAT
Jacksonville Sports Medicine Program
904.202.4332
Kim Csabi, MESS, ATC, LAT
Daytona State College
386.506.3989
Lary Beal
Volusia County Schools
386.734.7190
Gary Marks
Volusia County Schools3
386.734.7190
Jaime Pinyan
Volusia County Schools
386.235.1722
Staci Hahn
Volusia County Schools
386.968.0013
Beth Hooks
Florida Hospital
Dawn Emerick, CEO
Health Planning Council NE Florida
Joyce Case
Health Planning Council of NE Florida
386.323.2046
Effective July 1, Chapter 458 and 459, Florida Statutes outlines specific steps for
return to play (RTP) following a concussion in sports.
This 2012 law requires an athlete with a suspected concussion to be immediately
removed from participation and directed to a physician (MD or DO), for evaluation
and management of this injury. No student athlete should return to play on the
same day.
Return to activity requires:
1. The athlete to be completely symptom free and off all medications
associated with this concussive incident
2. The athlete to have a normal neurological exam
3. All pre-season computer neuropsychological testing, if available, must be
returned to baseline
4. Once the athlete is free of symptoms, the physician is directed to follow the
instructions on Form AT 18
5. A signature is required to initiate RTP. A second signature is required to
return the athlete to competition once graded RTP is complete with no symptoms
Form AT18 is attached for your convenience. Additional copies may be obtained
from the available at Northeast Florida Counts website www.nefloridacounts.org
Initiative Center under ’quick links.’
For current and up to date information on concussions, visit:
http://www.cdc.gov/concussioninyouthsports/
http://www.seingstarsfoundation.org
http://www.fhsaa.org/forms/general-athletic/at18
Sincerely yours,
Volusia/Flagler Concussion Task Force

VOLUSIAFLAGLER
CONCUSSION
TASK FORCE
C oncussion Information Sheet
Parent / Caregiver:
Your student athlete was removed from sports activity today after sustaining an injury to his/her head.
____________ ____________________________________________________ _________________________
DATE LOCATION TIME
Concussion (Definition/Description): A concussion is a serious injury to the brain resulting in a
disturbance of brain function. By definition, a concussion is an injury to the brain that can cause both
short‐term and long‐term problems. Below are signs and symptoms your student athlete may experience
after sustaining a concussion.
Concussion Symptom Checklist (not meant to be all‐inclusive)
☐Headache ☐Feeling Foggy ☐Irritable Behavior ☐Change in sleep patterns
☐Nausea/Vomiting ☐Sensitive to light ☐Clumsy ☐Balance Problems
☐Sensitive to noise ☐Ringing in Ears ☐Change in personality ☐Dizziness
☐Slurred speech ☐Slow to answer ☐Loss of Consciousness ☐_________________
☐Blurry/Double Vision ☐Memory problems ☐Stiffness in neck ☐_________________
☐Confusion
☐_________________
________________________________________ ______________________________________
Evaluated by (Please print) Phone Number
Treatment and Recovery
What are your next steps?
Within the next 24‐48 hours, make sure your student athlete rests, and drinks plenty of fluids (water and
sports drinks). If needed provide pain relievers (i.e. acetaminophen) that have previously been tolerated.
If, after 48 hours, the student athlete is asymptomatic then proceed with doctor visit.
*** IF THE STUDENT ATHLETE BEGINS TO FEEL WORSE OR HAS IN INCREASED INTENSITY
OF SYMPTOMS – THIS IS AN INDICATION THAT YOU MUST IMMEDIATELY TAKE HIM/HER
TO THE NEAREST EMERGENCY ROOM FOR FURTHER EVALUATION.***
The purpose of this evaluation is to discover if some other injury may exist or if the brain is not healing
from the injury. If no other injuries are found the evaluating physician may prescribe additional care
measures to help reduce your student athlete’s discomfort.
Please note: Normal brain and skull imaging studies (CT scans, MRI’s) by themselves do not rule
out a concussion or predict a safe return to physical activity.

VOLUSIAFLAGLER
CONCUSSION
TASK FORCE
If you do not visit the emergency room, follow these suggestions:
1. Arrange a visit with your family physician or other healthcare professional that has been trained
in the evaluation and management of concussion. Share with him/her this injury evaluation you
received. Bring this Concussion Information Sheet with you to the doctor’s visit.
2. Allow your student athlete to rest in a quiet area. It is recommended that you eliminate most
external brain stimuli including bright lights, loud noises, TV, computers, reading, video gaming
texting, etc… Limit visitors so as not to overstimulate the healing student athlete.
3 Notify your student athlete’s school of the injury; it is possible that educational modifications will
be needed to assist your student athlete during healing. Please discuss with your family physician
for more information. Likewise, it may be necessary to delay the student athlete’s return to an
after‐school or weekend job until it is deemed safe to perform these activities.
4. No form of athletic activity should be resumed prior to formal clearance by your physician.
Sleeping
It is typical for a student athlete who has suffered a concussion to become tired and lethargic. It is
acceptable for your student athlete to sleep. However, excessive sleepiness and lethargy would be cause
to seek further evaluation from a medical doctor.
Return to Play (RTP) Criteria/Concussion Management
Concussion, like other injuries, requires a rest/recovery period so that the brain has time to heal. Healing
is an individual process, so no specific time frame can be given. Florida State Statute HB 291 requires that
a student athlete is evaluated by a physician (MD or DO) prior to any return to play. The FHSAA
concussion action plan listed below is the accepted process of return to play safely after a concussion.
1. No student athlete should return to play or practice on the same day of a suspected concussion.
“When in doubt, sit them out!”
2. Any student athlete suspected of having a concussion must be evaluated by an appropriate
healthcare professional as soon as possible and practical.
3. Any student athlete who has sustained a concussion must be medically cleared by a physician (MD
or DO) prior to resuming participation in any practice or competition.
4. After evaluation and examination, return to play must follow a step‐wise protocol as defined by
the graded Return to Play protocol form and under the supervision of a physician, athletic trainer,
coach, or other healthcare professional. Form AT 18 (Post Head Injury/Concussion)
5. A written medical clearance from a physician is required for return to competition.
For current and up‐to‐date information on concussions, visit www.cdc.gov/concussioninyouthsports/
PLEASE TAKE THIS FORM WITH YOU TO YOUR PHYSICIAN VISIT SO HE/SHE IS AWARE OF WHAT
HAS HAPPENED